Current Approaches for Phenotyping as a Target for Precision Medicine in COPD Management

ABSTRACT

The study of airway diseases continues to present several challenges for modern medicine. The different disease presentations with variables and overlapping features may result in a real challenge for the clinician. In this context, the concept of precision medicine has started to emerge in order to give answers to some of these challenges from a diagnostic and therapeutic point of view. The main reasons to target for precision medicine in chronic obstructive pulmonary disease (COPD) include that there is variability in the clinical presentation, there is no correlation between the different clinical variables at the patient level, there are a number of relevant clinical variables associated with outcomes, we do have specific therapies for specific patient types, and that there is variability in the clinical response to different therapies. To bring precision medicine into clinical practice several approaches have been used, including the use of independent variables to identify subjects, the use of multidimensional indexes, the so-called clinical phenotypes, and the approximation by the so-called treatable traits. All these approaches have their strengths and weaknesses which are reviewed in the present document. Although there is no universally accepted proposal, the available initiatives provide us with a framework on which to start working and move toward precision medicine in COPD, with the ultimate goal of bringing the best possible medicine to each patient in particular.

KEYWORDS:

• COPD
• clinical phenotypes
• multidimensional evaluation
• precision medicine

Declaration of interest

JLLC declares relevant financial activities outside the submitted work during the last 36 months in the form of grants, personal fees, or nonfinancial support from Novartis, Boehringer Ingelheim, Menarini, Grifols, Esteve, Ferrer, Rovi, Gebro Pharma, Bial, and Teva. SC declares relevant financial activities outside the submitted work during the last 36 months in the form of grants, personal fees, or nonfinancial support from GlaxoSmithKline, Novartis Farma SPA, Chiesi SPA, AstraZeneca, Valeas, Boehringer Ingelheim, and Guidotti Malesci.